Ugandans show correct way to tackle AIDS


The promotion of condoms as a means of stopping the spread of AIDS andsexually transmitted diseases is irresponsible, writes Dr Miriam Duggan.

World AIDS Day has recently passed and we have been presented with the global magnitude of the AIDS pandemic. Africa has been the worst affected area, where the consequences for families, for children left orphans and for the social and economic well-being of countries at large have been devastating. Various strategies, mainly the use of condoms, have been advocated to curtail the spread of this fatal disease. However, what is needed, as has been shown in Uganda, is to address the root causes of the spread of the disease.

In 1991 at the International Conference on AIDS and Sexually Transmitted Diseases (ICASA) held in Senegal, which I attended, some representatives from several African countries met to see how best to approach the further spread of HIV/AIDS. At the end of four days of discussion the following statement was drawn up:

"We believe that individuals and whole communities have the inherent capacity to change attitudes and behaviours. The power to fulfil this capacity is often denied or is not exercised ... This power must now be recognised, called forth and supported ...We recognise that behaviour change is inextricably linked to such basic human values as care, love, faith, family and friendship, respect for people and cultures, solidarity and support ...We believe that behaviour change is the most essential strategy in overcoming the HIV pandemic."

Having worked in Uganda as a gynaecologist, serving on the Uganda AIDS Commission, and working on an AIDS prevention programme for 10 years, I can recommend this approach.

Uganda had the courage to address the attitudes and behaviours that were spreading the virus. Value-based programmes and behaviour change workshops were run throughout the country. Young people were helped to look critically at their lifestyles and attitudes, and helped to make responsible choices - choices that would promote life and health. As a result many people made commitments not to have extramarital sex, and to avoid, for example, over-indulging in drink or drugs which results in less control of their behaviour. This demanded much work. President Museveni, the First Lady, as well as many other prominent people and churches supported this approach.

A Harvard University study on the prevention of AIDS in Uganda credits abstinence education with "significant effectiveness in reducing AIDS in Uganda". The study found that from the late 1980s to 2001 the number of pregnant women infected with HIV dropped from 21.2 per cent to 6.2 per cent. By contrast in Botswana, where condoms are officially promoted as the solution, 38 per cent of pregnant women were HIV positive in 2001 (reported in Life Site Daily News, July 22nd, 2002).

The promotion of condoms as a way to stop the spread of AIDS and sexually transmitted diseases (STDs) is irresponsible. The most a condom will do is reduce the risk of infection. The medical literature clearly shows that condoms have a 10 to 13 per cent failure rate for pregnancy and a 10 to 20 per cent failure rate for the HIV virus for a multitude of reasons. Even the Durex manufacturer of condoms state on its website that: "For complete protection from HIV and STDs the only totally effective measure is sexual abstinence or limiting sexual intercourse to mutually faithful uninfected partners."

AIDS is a killer disease and to accept a 10 to 20 per cent failure rate is playing Russian roulette with people's lives. Recreational sex has many adverse side effects apart from the risk of AIDS infection; one has only to read about the increased rates of infertility due to chlamydia, the increase in syphilis, not to mention the consequences of teenage pregnancy. People have the right to be told the truth so that they can make responsible choices.

There are many voices in Ireland today advocating the inclusion of "safe sex" in sex education programmes in schools as a means of reducing pregnancy and STDs. The message being conveyed to our young people is that it's alright to have sex so long as you use a condom - this is irresponsible. Such programmes promote promiscuity, pregnancy, abortions and STDs. STDs in our country are increasing at an alarming rate among our young people. It should also be remembered that the statutory age limit for engaging in sexual intercourse is 16 for girls and 17 for boys.

At another ICASA conference in Zambia in 1999, the Youth Forum made the following recommendation: "You tell us that because 20 per cent of the youth are having sex, you provide us all with 'safe sex' education and a supply of condoms. Why not uphold the 80 per cent who are not having sex and encouraging the others to come back on board?"

In Ireland, the ministers for Health and Children and for Education and Science should take a lead from the value-based programmes promoted in Uganda and heed the Youth Forum's recommendations at the conference in Zambia. Young people have a latent idealism and are able to make responsible choices if encouraged and supported. Good sex education should include an appreciation of each individual, the wonder of the gift of procreation and the gift of life.

In an article by Dr P.B. Marwood published in the British Journal of Hospital Medicine, "AIDS a conspiracy of misinformation", states that: "Church leaders proclaim abstinence as the only real protection. I fear that they are correct. It would seem that virginity and faithfulness will again become fashionable."

Dr Miriam Duggan (FRCOG), a member of the Franciscan Missionary Sisters for Africa, is a gynaecologist who has worked in Uganda and southern Africa on anti-AIDS campaigns